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Quarterly Provider Updates

Welcome to the Centers for Medicare & Medicaid Services' (CMS) Quarterly Provider Update (QPU). By publishing this Update, we intend to make it easier for providers, suppliers, and the general public to understand the changes we are proposing or making in the programs we administer (for example, Medicare, Medicaid, and the Children's Health Insurance Program (CHIP).

CMS publishes this Update at the beginning of each quarter to inform the public about the following:

Regulations and major policies currently under development during this quarter.

Regulations and major policies completed or cancelled.

New/Revised manual instructions

CMS regulations establish or modify the way CMS administers its programs. CMS' regulations may impact providers or suppliers of services or the individuals enrolled or entitled to benefits under CMS programs.

Quarterly News Update

On December 8, 2003, President Bush signed into law the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Pub. L.108-173). CMS acted quickly to publish the documents that implement provisions of the Medicare Modernization Act. Those documents are listed on the Medicare Modernization Update Page.

Based on our review of the new legislation, we may publish additional regulations that are not identified in this quarter's update. Subscribers to this Update will be notified if we publish additional regulations. In addition, we will release a number of program notices and memorandum that will clarify certain provisions of Pub. L. 108-173.

For rules with comment periods published beginning January 30, 2004, CMS began accepting electronic comments. Commenters may submit electronic comments via the eRulemaking Page before the close of the comment period for a published document.

Publication Schedule

CMS generally limits the number of days it publishes regulations and notices in the "Federal Register" to the fourth Friday of each month. By limiting the number of days that it publishes regulations and notices, CMS hopes to add an element of predictability to its communications with the public and reduce the time it takes for the public to research changes. Some of our regulatory work, however, is mandated by specific statutory publication dates, and CMS will continue to comply with the statutory requirements.

Further, CMS intends to publish the Update on the first business day of each quarter (January, April, July, and October) on the CMS web site.

CMS-QPU Listserv

You can receive changes to this Update, as CMS makes them, by subscribing to the CMS-QPU Listserv.

Proposed Regulations

CMS publishes its regulations in the daily national "Federal Register". The "Federal Register" is available at many public libraries and colleges. To view regulations and notices published this quarter, refer to the Listing of Quarterly Provider Updates.

A "proposed rule" or proposed regulation announces CMS' intent to issue a new regulation or modify an existing regulation. A proposed regulation also solicits public comments during a comment period. It sets forth proposed amendments to the Code of Federal Regulations (CFR), but does not amend the CFR.

By law, anyone can participate in the rulemaking process by commenting in writing on the regulations CMS proposes. CMS encourages public input and carefully considers these comments before it develops a final regulation. CMS generally receives public comments on its proposed regulations.

The "comment period" specifies how long CMS will accept public comments. Usually, the record – or docket – stays open for comments at least 30 days for Medicaid regulations and 60 days for Medicare regulations, though some comment periods may differ. (Weekends and holidays are counted in determining the closing date of a comment period.)

To submit an electronic comment on a regulation for which CMS is accepting electronic comments, please visit the eRulemaking Page.

Alternatively, you may submit your written comments by mailing or delivering your comment(s) to the location cited in the regulation. CMS can process comments more effectively if they are presented – either written legibly or typed – on 8-1/2-inch by 11-inch paper.

Here are some other suggestions for ensuring your comment(s) have the greatest possible impact:

Refer to the regulation title and the CMS number, listed at the beginning of the regulation (for example, Revisions to Payment Policies under the Physician Fee Schedule for Calendar Year 2004, CMS-1476-P).

Clearly indicate if you are for, or against, the proposed regulation or some part of it and why. CMS regulatory decisions are based largely on law, clinical and scientific evidence, and program experience. CMS reviewers look for reasoning, logic, and good science in the comments they evaluate.

Include a copy of articles or other references that support your comments. Only relevant material should be submitted.

If an article or reference is in a foreign language, it must be accompanied by an English translation verified to be accurate. A copy of the original publication should accompany translations.

To protect privacy when submitting medical information, delete names or other information that would identify patients.

Deliver comments before 5:00 pm of the last day of the comment period.

Comments Received

CMS logs in all public comments received timely and places them in the official rulemaking record. All comments are public information that may be reviewed by anyone by calling the telephone number listed in the "Federal Register" document. CMS displays public comments received timely through the electronic website on its public website.

Final Regulations

After considering public comments that it receives by the close of the comment period, CMS may develop and publish a final regulation. If the final regulation has a significant impact on a significant number of entities or its impact results in $100 million or more, the final regulation is generally effective 60 days after the publication date. At the time CMS forwards the rule for publication, it also forwards the regulation to the Government Accountability Office (GAO) and both houses of the Congress for review.

A final regulation that does not meet the "significant impact" criteria, is generally effective 30 days after publication. If CMS finds good cause to waive the delay in the effective date of a final regulation because the delay is unnecessary, impractical, or contrary to the public's interest, or the statute permits waiving the delay, the final regulation is effective upon publication.

Previous Publications

The Update also includes a listing of the regulations, notices, and manual instructions published in the previous quarter.

Other Procedures

In addition to proposed and final regulations, the Update includes all non-regulatory changes to Medicare and Medicaid, including new and revised manual instructions and any other instructions that may impact providers or suppliers of services or to individuals enrolled or entitled to benefits under the CMS programs.